3. 4. 5. 6. Name of Certifying Agency Federal Bureau of Investigations Name of Cenifying Official Title of Certifying Official Special Agent Division/Office of Certifying Official New York Field Office Agency Mailing Address Street Number and Name 26 Federal Plaza City or Town New York Daytime Telephone Number

Bureau of Investigations Name of Certifying Official 2.a. Family Name (Last Name) 2.b. Given Name (First Name) 2.c. Middle Name 3. Title and Division/Office of Certifying Official Name of Head of Certifying Agency 4.a. Family Name (Last Name) 4.b. Given Name (First Name) 4.c. Middle Name 5.a. Street Number and

ion 1. 2. 3. 4. 5. 6. Name of Certifying Agency 'Federal Bureau of Investigations Name of Certifying Official Title of Certifying Official Division/Office of Certifying Official Agency Mailing Address Street Number and Name 26 Federal Plaza City or Town New York Daytime Telephone Number 7. Fax Number For USC

Information 1. Name of Certifying Agency Federal Bureau of Investigations 2. Name of Certifying Official 3. Title of Certifying Official 4. Division/Office of Certifying Official 5. Agency Mailing Address Street Number and Name For USCIS Use Only Returned Date Date Resubmitted Date Date Reloc Sent Date Da

ifying Agency Federal Bureau of Investigations 2. Namc of Certifying Official 'Amanda Young 3. Title of Certifying Official Special Agent 4. Division/Office of Certifying Official 'New York Field Office 5. Agency Mailing Address Street Number and Name For USCIS Use Only Returned Date Date Resubmitted Date Da